Women, Addiction and Prison: An Interview with Dr. Stephanie Covington

Stephanie Covington, Ph.D., author of Hazelden Publishing books, A Woman’s Way Through The Twelve Steps, Women and Addiction: A Gender-Responsive Approach and Beyond Trauma, is currently being featured in the new OWN: Oprah Winfrey Network docu-series, “Breaking Down the Bars,” which premiered on Tuesday, February 15. The original seven-episode series follows the journey women prisoners take in an attempt to rebuild their lives, exploring the dramatic transformation of a group of female prisoners during their time at the Rockville Correctional Facility in Indiana.

Crossroads for Women‘s clinical director and communications specialist had the opportunity to interview Dr. Covington about women, addiction and prison, and issues relating to gender-specific addiction treatment for this blog. Following are a few things we learned from our conversation with Dr. Covington.

Working with women with addiction and trauma issues

Dr. Covington first points out that when you are talking about women and addiction, there’s typically trauma involved as well. Clinicians should get out of the mindset that the combination of an addiction and trauma is unusual. It is actually very common, particularly for women.

Dr. Covington also pointed out that substance abuse treatment in the past did not necessarily deal with trauma. The thought was that a clinician would help a client deal with their substance abuse problems first, get them stable, and then move onto the trauma and mental health concerns. Dr. Covington sees a shift in treatment where clinicians can work with both issues at the same time. Treating both trauma and addiction at the same time can help women better understand the connection of the two.

The challenge for clinicians and treatment centers is creating trauma-informed environments.

How to address shame and guilt issues

First, Dr. Covington stresses the need to separate out shame and guilt. Guilt means I feel bad about something I’ve done. Shame means I’m ashamed about who I am. The stigma around women and addiction and negative messages out there shame women more so than men.

Dr. Covington points out that when we feel guilty, the way to change that feeling is to do things differently. You feel better about yourself when you start to do what she calls esteemable acts. When we feel better, we do better. One exercise she uses is to have women write down 3 esteemable acts they can do. The other piece for women is to understand they are not alone in their thinking. She used the example of mothers, “Every mother has mother guilt. See how common that is. It’s impossible to be a mother and not feel guilty.”

Ways to engage clients who are mandated to residential treatment programs from jail

Dr. Covington first points out that not all women in jail engage in criminal thinking. Some are simply there because of their actions related to their addiction. Other women, however, may have grown up in the jail environment so it is part of their culture, way of being. The reality for many of these jailed women is that they need to figure out how they are going to support themselves once they are out of jail. It’s tempting to go back to drug-dealing when the money is quick and easy rather than going to a minimum wage job at a fast food restaurant. They may also be attached to men with criminal behavior, which poses major risks.

As clinicians, Dr. Covington says, “We plant seeds. When women come into treatment and we try to save lives, we’re trying to plant seeds.” Sometimes we’re the first person to try and plant that seed or the last person. There may be a lot of intervention in between. If change doesn’t happen right away, sometimes it just means that the seed hasn’t sprouted yet.

Challenges working with women in jail / prison

Dr. Covington points out that the correctional system was never set up for substance abuse treatment. While corrections is a culture of control, treatment is a culture of change. This presents what Dr. Covington calls a culture conflict. While we are able to provide some services, they are minimal and not as pervasive as traditional treatment. And just because women are in jail, doesn’t mean they are not using. Unfortunately many are able to get drugs inside jail.

The other problem is that there is a huge discrepancy around the number of women who need treatment and the number who are getting it. She used the example of Michigan, where there are 1,700 encarcerated women. The substance abuse unit holds only 100 beds, allowing only 200 women per year treatment.

Dr. Covington sees the system as being somewhat short-sided. Women end up back in jail because we’re not providing enough services to help them with their issues and struggles.

Getting women in prison to open up and participate in group therapy

It is not uncommon for women to be told by staff and peers to not talk about their lives and to keep to themselves while doing their time. Women quickly learn that they can only survive in jail by having friends and creating connections with other women.

Women are relational beings. We don’t heal in isolation. We need connections. And that connection piece is vitally important because once women feel those connections, they are able to open up more and address the problems that they are having.

Dr. Covington, a nationally-recognized clinician, author and lecturer, is a pioneer in the field of women’s issues, addiction and recovery. She has developed an innovative, gender-specific and trauma-informed approach to the treatment needs of women and girls that results in effective services in public, private and institutional settings. For more information on Dr. Covington’s work, please visit her website.

Crossroads is CARF accredited, a member of the National Association of Addiction Treatment Providers, and is committed to providing high quality care to women, men, and families struggling with substance use and mental health disorders.